Pay for performance and outcomes measurement

Physician blogger DB makes some good points in this post about pay for performance--namely, that it can hurt overall patient health by discouraging docs from taking on the sickest patients. Instead, he proposes that

One way to avoid this is to evaluate process rather than outcome. If one documents that the patient refuses to have an eye exam, a process measure could still give one credit for offering the eye exam.

Also, as DB points out, these report cards would only measure certain things, but wouldn't cover "diagnostic acumen, bedside manner and recognition of drug side-effects." Something to think about when designing outcomes measurement for CME, I would think.